Provider Demographics
NPI:1073798591
Name:THOMAS JOHN ZAYDON JR MD PA
Entity Type:Organization
Organization Name:THOMAS JOHN ZAYDON JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZAYDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-3030
Mailing Address - Street 1:3661 S MIAMI AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4200
Mailing Address - Country:US
Mailing Address - Phone:305-856-3030
Mailing Address - Fax:305-285-9423
Practice Address - Street 1:3661 S MIAMI AVE STE 509
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4200
Practice Address - Country:US
Practice Address - Phone:305-856-3030
Practice Address - Fax:305-285-9423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS JOHN ZAYDON JR MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044137208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty